Canadian doctor rallies colleagues against ‘tyrannical’ attack on conscience and sound medicine

LifeSite News

Steve Weatherbe

Dr. Martin Owen, a Calgary family doctor, has taken on the task of rousing his fellow practitioners to the danger posed to their integrity by policies being pushed by professional regulators in several provinces.

“My conscience is on the line,” Owen said in a chain e-letter. “If I lived in Ontario, I’d probably move my 7 children to another province so I could avoid the tyranny over my professional medical judgment and my conscience.”

Appalled by the Ontario College of Physicians and Surgeons’ new requirement for all doctors, regardless of moral objections, to do or refer abortions,  Owen has launched a website, freedomofconscience.ca, with Ezra Levant just before the latter’s Sun News Network folded, and sent chain e-letters to colleagues asking them to vote in a “poorly worded” CBC poll about the issue. And as with a chain letter, he has asked his recipients to pass his message on to 10 colleagues.

“The time has come when doctors now need to fight for the right not to perform abortions, prescribe birth control, or refer patients for controversial procedures,” the email stated. . . [Full text]

 

Saskatchewan policy forcing doctors to violate conscience fails to win enough support: final decision delayed

LifeSiteNews

Steve Weatherbe

A move to force Christian doctors in Saskatchewan to do abortions, assist at suicides, or refer patients to other willing doctors failed to win sufficient support at a meeting of the College of Physicians and Surgeons’ ruling council Thursday.

Faced with 4,400 hostile letters, many instigated by the Catholic Diocese of Saskatoon, the council decided to continue discussion at an emergency meeting on Saturday, and likely to put off a final vote until June, after a full public consultation.

“They weren’t all on the same page at all,” said Colette Stang, the head of Saskatchewan Pro-Life Association. “So it was a bit of a relief. I was pleased the decision wasn’t made.”. . . [Full text]

Court challenge raises issue of “reasonable apprehension of bias”

Sean Murphy*

The College of Physicians and Surgeons of Ontario is facing a court challenge by the Christian Medical and Dental Society and the Canadian Federation of Catholic Physicians’ Societies.  They have filed an application in the Ontario Superior Court of Justice asking for an injunction against enforcement of the College’s controversial new policy, Professional Obligations and Human Rights.  According to the application the College acknowledged that it had received 15,977 submissions during the second consultation concerning the policy, which ended on 20 February, 2015.  The great majority of submissions opposed the policy.

While the consultation ended on 20 February, a working group wrote the final version of the policy by 11 February, at least nine days before the consultation closed.  This is one of the factors that gives rise to concern about what the CMDS application calls either “actual bias” or “a reasonable apprehension of bias” on the part of the working group.

On this point, the statistics provided by the College are of interest.

submissionsAccording to the briefing note supplied to the College Council, by 11 February, 2015 the College had received 3,105 submissions.  This means that 12,872 submissions were received from 12 to 20 February inclusive.  In other words, over 80% of the submissions in the second consultation were received after the final version of the policy was written.

Moreover, allowing sufficient time to receive feedback is only the beginning.  Having received them, one would expect that a working group seriously interested in feedback would allow sufficient time to review and analyse the submissions.

During the 64 days of consultation ending 11 February, the College received an average of almost 50 submissions per day.  There were 43 working days during that period.  Assuming someone spent eight full hours every working day reading the submissions, it would have taken one person about seven minutes to review each one.

analysisHowever, during the nine days of consultation ending 20 February, the College received an average of 60 submissions every hour.  With 16 working days available from 12 February to 5 March inclusive, the day before the Council meeting, one person reading eight hours a day would have had no more than 36 seconds to review each submission.

Presumably this will be one of the issues to which the attention of the court will be directed if the case goes to trial.

Christian doctors’ group says new college policy infringes on freedom of conscience

Christian Medical and Dental Society seeks protection from a College of Physicians rule requiring doctors to refer patients seeking abortions and, once it’s legal, euthanasia.

Toronto Star

Lauren Pelly

With physician-assisted suicide on the horizon, the Christian Medical and Dental Society of Canada is asking the Ontario Superior Court to declare that a new regulatory policy infringes upon doctors’ freedom of conscience.

The society, which represents close to 1,700 members, filed documents in court on Friday regarding the CPSO’s Professional Obligations and Human Rights policy that was announced on March 6. The policy means doctors who refuse to refer patients for services on religious and moral grounds, including abortions, could face discipline from their regulating body. . . [Full Text]

 

Opinions on conscientious objection to induced abortion among Finnish medical and nursing students and professionals

BMC Medical Ethics 2015, 16:17  doi:10.1186/s12910-015-0012-1

Petteri Nieminen, Saara Lappalainen, Pauliina Ristimäki, Markku Myllykangas, Anne-Mari Mustonen

Abstract: Conscientious objection (CO) to participating in induced abortion is not present in the Finnish health care system or legislation unlike in many other European countries.

Methods: We conducted a questionnaire survey with the 1st- and the last-year medical and nursing students and professionals (548 respondents; response rate 66-100%) including several aspects of the abortion process and their relation to CO in 2013.

Results: The male medical respondents chose later time points of pregnancy than the nursing respondents when considering when the embryo/fetus ‘becomes a person’. Of all respondents, 3.5-14.1% expressed a personal wish to CO.

The medical professionals supported the right to CO more often (34.2%) than the nursing professionals (21.4%), while ≥62.4% could work with someone expressing CO. Yet ≥57.9% of the respondents anticipated social problems at work communities caused by CO.

Most respondents considered self-reported religious/ethical conviction to be adequate for CO but, at the same time, 30.1-50.7% considered that no conviction would be sufficient. The respondents most commonly included the medical doctor conducting surgical or medical abortion to be eligible to CO.

The nursing respondents considered that vacuum suction would be a better justification for CO than medical abortion. The indications most commonly included to potential CO were second-trimester abortions and social reasons.

Among the medical respondents, the men were more willing to grant CO also in case of a life-threatening emergency of the pregnant woman.

Conclusions: While the respondents mostly seemed to consider the continuation of adequate services important if CO is introduced, the viewpoint was often focused on the staff and surgical abortion procedure instead of the patients. The issue proved to be complex, which should be taken into consideration for legislation.

[Full text]

Ontario physicians seek court protection from CPSO policy

For immediate release

Christian Medical and Dental Society of Canada

TORONTO – Dr. Diane Haak, President of the Christian Medical and Dental Society (CMDS), Woodstock emergency room physician Dr. Michelle Korvemaker, and CMDS executive director Larry Worthen announced, today, that they have filed documents asking the Court to declare that a new College of Physicians and Surgeons (CPSO) policy infringes upon Ontario doctors’ freedom of conscience.

“My conscience and religious beliefs do not allow me to engage in procedures to which I have a moral, ethical or religious objection. I, and all physicians in Ontario, have the right to practice medicine according to my conscience and free from state compulsion,” said Dr. Korvemaker.

Dr. Haak added, “This policy may force physicians who do not feel they can refer or perform procedures that go against their conscience to leave the practice of medicine.”

CMDS filed an application for declaratory relief asking the court to declare that portions of the CPSO’s March 6, 2015, policy breach sections of the Canadian Charter of Rights and Freedoms.

Said Larry Worthen, ”We firmly believe that it is possible to ensure access to  controversial procedures and pharmaceuticals in Ontario without trampling upon the constitutional rights of physicians”

The CPSO policy violates freedoms of conscience and religion by requiring physicians and surgeons to make formal referrals when their consciences don’t permit their performing a procedure or treatment. The policy also violates Charter freedoms by requiring them to perform procedures when certain circumstances arise.

 CMDS Canada represents some 1600 physicians and dentists across Canada (http://www.cmdscanada.org). The Canadian Federation of Catholic Physician’s Societies is also supporting the application.

-30-

For more information, please contact:      Larry Worthen  902-880-2495

Doctors grapple with organ donation question

National Post

Sharon Kirkey

As the nation awaits legalized doctor-assisted death, the transplant community is grappling with a potential new source of life-saving organs  –  offered by patients who have chosen to die.

Some surgeons say every effort should be made to respect the dying wishes of people seeking assisted death, once the Supreme Court of Canada ruling comes into effect next year, including the desire to donate their organs.

But the prospect of combining two separate requests  –  doctor-assisted suicide and organ donation  –  is creating profound unease for others. Some worry those contemplating assisted suicide might feel a societal pressure to carry through with the act so that others might live, or that it could undermine struggling efforts to increase Canada’s mediocre donor rate. . . [Full text]

The doctors’ dilemma

National Post (Editorial)

The College of Physicians and Surgeons of Ontario recently voted to require doctors who refuse to provide certain services for reasons of conscience to provide referrals to doctors who will.

The new policy, enacted over the objections of the Ontario Medical Association, is a marked departure from the old. It paints medicine as a battlefield, with equal and opposite freedoms repeatedly colliding. Thus the college graciously agrees to limit physicians’ freedom of conscience in order to safeguard patients’ right of access.

The problem is that “right of access” is a college creation, while freedom of conscience is enshrined in the Charter of Rights. Doctors make informed decisions about treatment constantly. If they did not refuse to prescribe some treatments and suggest others, they would not be professionals. A patient storming into an office demanding amputation to treat a broken arm does not have “right of access.” . . . [Full text]

Bill OK’d by committee would give more information to patients

The State Journal Register

Doug Finke, State Capitol Bureau

A bill designed to ensure patients are given treatment information when their health-care providers invoke the state’s Right of Conscience Act was approved by the Illinois Senate Judiciary Committee Tuesday.

Under Senate Bill 1564, health-care providers would be required to establish written protocols that provide patients with information about the treatment options available and how they can get access to those options. [Full text]

 

Gagging conscience, violating humanity

Sean Murphy*

Introduction

In 2008, when the Council of the College of Physicians and Surgeons of Ontario was considering the final draft of an earlier policy, Physicians and the Human Rights Code, a member of the Council seems to have been troubled by the policy direction being given to the Colllege by the Ontario Human Rights Commission (OHRC).

Speaking during the Council meeting, he drew his colleagues’ attention to a chilling New England Journal of Medicine article by Holocaust survivor, Elie Wiesel: “Without conscience.”1 It was about the crucial role played by German physicians in supporting Nazi horrors. “How can we explain their betrayal?” Wiesel asked. “What gagged their conscience? What happened to their humanity?”2

Now, however, to the applause of the OHRC,3 the College of Physicians and Surgeons of Ontario has approved a policy to gag the consciences of physicians in the province,4 and Saskatchewan is next in line.5  We may soon begin to discover the answers to Wiesel’s questions.

There is no duty to do what is believed to be wrong.

Policies like those adopted in Ontario and proposed in Saskatchewan are incoherent because they purport to include a duty to do what one believes to be wrong in a code of ethics or ethical guidelines, the very purpose of which is to encourage physicians to act ethically and avoid wrongdoing.

Beyond this, when discussion about difficulties associated with the exercise of freedom of conscience in health care is repeatedly characterized as “the problem of conscientious objection,”6 it becomes clear that the underlying premise is that people and institutions ought to do what they believe to be wrong, and that refusal to do what one believes to be wrong requires special justification.  This is exactly the opposite of what one would expect. Most people believe that we should not do what we believe to be wrong, and that refusing to do what we believe to be wrong is the norm. It is wrongdoing that needs special justification or excuse, not refusing to do wrong.

The inversion is troubling, since “a duty to do what is wrong” is being advanced by those who support the “war on terror.” They argue that there is, indeed, a duty to do what is wrong, and that this includes a duty to kill non-combatants and to torture terrorist suspects.7 The claim is sharply contested,8 but it does indicate how far a duty to do what is wrong might be pushed. In Quebec, in Ontario and in Saskatchewan it is now being pushed as far as requiring physicians to participate in killing patients, even if they believe it is wrong: even if they believe that it is homicide.9

This reminder is a warning that the community must be protected against the temptation to give credence to the dangerous idea that is now being advanced by medical regulators in Canada: that a learned or privileged class, a profession or state institutions can legitimately compel people to do what they believe to be wrong – even gravely wrong – and punish them if they refuse.

Forcing someone to do wrong is a violation of humanity, not a limitation of freedom.

Attempts to suppress freedom of conscience and religion in the medical profession are often defended using a statement of the Supreme Court of Canada: “the freedom to hold beliefs is broader than the freedom to act on them.”10

Click here to access Journal.

Click here to access Journal.

The statement is not wrong, but it is inadequate. It is simply not responsive to many of the questions about the exercise of freedom of conscience that arise in a society characterized by a plurality of moral and political viewpoints and conflicting demands. More refined distinctions are required. One of them is the distinction between perfective and preservative freedom of conscience, which reflects the two ways in which freedom of conscience is exercised: by pursuing apparent goods and avoiding apparent evils.11

It is generally agreed that the state may limit the exercise of perfective freedom of conscience if it is objectively harmful, or if the limitation serves the common good. Although there may be disagreement about how to apply these principles, and restrictions may go too far, no polity could long exist without restrictions of some sort on human acts, so some limitation of perfective freedom of conscience is not unexpected.

If the state can legitimately limit perfective freedom of conscience by preventing people from doing what they believe to be good, it does not follow that it is equally free to suppress preservative freedom of conscience by forcing them to do what they believe to be wrong. There is a significant difference between preventing someone from doing the good that he wishes to do and forcing him to do the evil that he abhors.

We have noted the danger inherent in the notion of a “duty to do what is wrong.” Here we add that, as a general rule, it is fundamentally unjust and offensive to suppress preservative freedom of conscience by forcing people to support, facilitate or participate in what they perceive to be wrongful acts; the more serious the wrongdoing, the graver the injustice and offence. It is a policy fundamentally opposed to civic friendship, which grounds and sustains political community and provides the strongest motive for justice. It is inconsistent with the best traditions and aspirations of liberal democracy, since it instills attitudes more suited to totalitarian regimes than to the demands of responsible freedom.

This does not mean that no limit can ever be placed on preservative freedom of conscience. It does mean, however, that even the strict approach taken to limiting other fundamental rights and freedoms is not sufficiently refined to be safely applied to limit freedom of conscience in its preservative form. Like the use of potentially deadly force, if the restriction of preservative freedom of conscience can be justified at all, it will only be as a last resort and only in the most exceptional circumstances.

None of these conditions have been met in Ontario or in Saskatchewan.


Notes:

1.  Email to the Administrator, Protection of Conscience Project, from P__ H__ (present at College Council meeting 18 September, 2008) (2014-02-11, 10:10 am)

2.  Wiesel E. “Without Conscience.N Engl J Med 352;15 april14, 2005 (Accessed 2014-02-24)

3.  Letter from the Office of the Chief Commissioner, Ontario Human Rights Commission, to the College of Physicians and Surgeons of Ontario, dated 19 February, 2015, Re CPSO Draft Policy: Professional Obligations and Human Rights

4.  College of Physicians and Surgeons of Ontario, Policy #2-15: Professional Obligations and Human Rights (Updated March, 2015) (Accessed 2015-03-16)

5.  College of Physicians and Surgeons of Saskatchewan, Policy: Conscientious Refusal.

6.  For example, Cannold L. “The questionable ethics of unregulated conscientious refusal.”  ABC Religion and Ethics, 25 March, 2011. (Accessed 2013-08-11)

7.  Gardner J. “Complicity and Causality,” 1 Crim. Law & Phil. 127, 129 (2007). Cited in Haque, A.A. “Torture, Terror, and the Inversion of Moral Principle.” New Criminal Law Review, Vol. 10, No. 4, pp. 613-657, 2007; Workshop: Criminal Law, Terrorism, and the State of Emergency, May 2007. (Accessed 2014-02-19)

8.  Haque, A.A. “Torture, Terror, and the Inversion of Moral Principle.” New Criminal Law Review, Vol. 10, No. 4, pp. 613-657, 2007; Workshop: Criminal Law, Terrorism, and the State of Emergency, May 2007. (Accessed 2014-02-19)

9.  Quebec has already passed a law purporting to legalize euthanasia: Murphy S. “Redefining the Practice of Medicine- Euthanasia in Quebec, Part 9: Codes of Ethics and Killing.” Protection of Conscience Project, July, 2014.  The Supreme Court of Canada has ordered legalization of physician assisted suicide and physician administered euthanasia.  When the ruling takes effect in early 2016, the Ontario and Saskatchewan policies, as written, will have the effect of forcing physicians unwilling to kill patients or help them kill themselves to find a colleague willing to do so.

10.  Trinity Western University v. College of Teachers, [2001] 1 S.C.R. 772, 2001 SCC 31 (Accessed 2014-07-29)

11.  This section of the paper draws from an extended discussion of the subject in Murphy S, Geunis S.J. “Freedom of Conscience in Health Care: Distinctions and Limits.” J Bioeth Inq. 2013 Oct; 10(3): 347-54